Expanding home care is risky without a workforce plan
by Stephen Duckett, Hal Swerissen
The pay rate for an experienced, full-time personal care worker who bathes and showers an older person at home is $23.67 per hour – about the same as a cinema cleaner, and less than a worker in waste management or at a fast-food outlet.
Unpaid additional work time, split shifts and highly variable hours are common and expected as part of the “caring” role traditionally associated with women – who make up more than 80 per cent of the home care workforce.
Not surprisingly, as Grattan Institute’s new report Unfinished business: Practical policies for better care at home outlines, there are workforce shortages and high levels of dissatisfaction among aged care workers. Vacancy rates are above 10 per cent for most staffing categories and staff turnover is high.
When older Australians need support, the overwhelmingly majority of them want to continue to live at home rather than go into residential aged care.
The federal government should be commended for dramatically expanding home care to try to meet this need in an ageing society. Soon, about 300,000 older Australians with more complex needs will be receiving personal care at home, with another 900,000 receiving lower-level services such as cleaning and gardening.
Clearly this is what older people want, but there are risks with the government’s plans to expand home care. It is too easy for poor-quality care to become a hidden problem if the home care workforce remains undervalued, underqualified and insecure.
Monitoring is limited in this field, but there are already reports of unexplained deaths, neglect, unreasonable use of force, coercion, stealing, and sexual, psychological and emotional abuse occurring in home care. The risks will increase as more older people with more complex needs are supported at home.
Good-quality home care requires staff to be properly qualified, supervised, supported and paid.
But despite workforce shortages and emerging competition from online and private aged care providers, most employers in the sector have not increased pay rates significantly.
About a third of community and personal service workers have no formal qualifications beyond a high school certificate.
Currently about 120,000 people work in home care. The overwhelming majority are personal care workers. We estimate about 58,000 additional workers will be needed to support the massive expansion of home care for older people over the next three years.
It will be difficult to attract these extra workers and make sure they provide high-quality home care unless the federal government puts in place a comprehensive workforce place plan – a plan that lifts the status and value of the aged care workforce.
Attraction and retention strategies need to be put in place, career paths established, training improved, and the trends towards casualisation and outsourcing reversed.
As part of the plan, personal care workers should be required to be registered and hold suitable minimum qualifications for the work they do.
But a workforce plan is not much use without adequate funding, and the federal government provides most of the funds for aged care. A work value case is now before the Fair Work Commission. If it is successful, the average award rate for a personal care worker would go up from $23.67 to $29.58 per hour – a welcome improvement.
The federal government has made no commitment to fund the outcomes of the Fair Work Commission assessment of pay and conditions. The government should make it clear that it will fund the implications of an independently assessed fair wage for aged care workers.
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